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WHO: Countries Seek Improvements in Malaria Tests

Manufactures and implementers of rapid diagnostic tests (RDTs), for checking malaria parasites, have agreed on a set of required features in an effort to scale up use.

The consensus was reached at a meeting in Antwerp earlier this week jointly organised by the Roll Back Malaria Partnership and the Institute of Tropical Medicine in the Belgian city, according to a statement made available to The Guardian in Dar es Salaam.

The statement said the Antwerp meeting generated a prioritised list of requirements to meet country needs after assessing the interchangeability and user-friendliness of nearly 60 different RDTs on the market.

Over the past one and a half years, an international group of researchers coordinated by Prof Jan Jacobs of the Institute of Tropical Medicine in Antwerp assessed similarities and differences between commercially available RDTs. The research was commissioned by the Roll Back Malaria Partnership.

“We found that many of the shortcomings, such as confusing names, unclear and non-consistent labeling and terminology, variations in design and test procedures can be overcome in the short term,” said Prof Jacobs.

“Field observations show that even small things like the readability of the test instructions can make the difference between a correct and a failed test,” he noted.

“Harmonisation will also benefit manufacturers. History shows that harmonisation boosts business and market, while a level playing field protects producers from unfair competition from cheaper but substandard products,” added the professor.

The efforts to harmonise RDTs are widely expected to accelerate the implementation of universal diagnostic testing in the public and private sectors, reduce the global requirements for antimalarial treatment and advance progress towards the Roll Back Malaria Partnership goal of near-zero malaria deaths by 2015.

“This latest move to harmonise rapid diagnostic tests will help all countries to implement the WHO recommendations to ‘test, treat and track’ malaria – and build the trust of health workers in the accuracy of the malaria test results,” said RBM Executive Director Dr Fatoumata Nafo, who addressed the gathering.

“By bringing together manufacturers, technical experts and end-users, we can improve these lifesaving tools, improve market flexibility and advance the scale up of malaria diagnosis and treatment,” added Dr Nafo.

John Oluoch Nyamuni of Kenya’s Health ministry said: “With easily identifiable, interchangeable and user-friendly RDTs, we can dramatically increase the testing of malaria – which will result in more rational administration of antimalarial medicines. Harmonisation will also help countries to buy a quality product.” Currently, RDTs vary in diagnostic performance, manner of use, and price.

Countries prefer to stay with the same RDT rather than go through the costly exercise of retraining thousands of health workers, or run the risk of error in the manipulation of the test, which can detect malaria parasites in a tiny drop of blood.

According to the World Malaria Report launched earlier this week by WHO, the numbers of procured rapid diagnostic tests is increasing, as is the reported rate of diagnostic testing in the public sector in the African Region, which increased from 37 per cent in 2010 to 61 per cent last year, and from 44 per cent to 64 per cent globally.

Most of the increase in testing in the Africa Region is due to increased use of RDTs, which accounted for 40 per cent of all cases tested in the region last year.

However, millions of people with suspected malaria still do not receive a diagnostic test, and many with confirmed infections do not receive appropriate malaria treatments.

Globally, an estimated 3.4 billion people are at risk of malaria, with 80 per cent of cases and 90 per cent of deaths estimated to occur in Sub-Saharan Africa.

Children under five years of age and pregnant women are most severely affected.

Between 2000 and 2012 the world has seen tremendous progress against malaria, with global deaths decreasing by about 45 per cent and deaths in Africa decreasing by 49 per cent.

Meanwhile global efforts to curb malaria have saved the lives of 3.3 million people since 2000, the World Health Organisation said on Wednesday.

It said this translates into cutting global death rates from the mosquito-borne disease by 45 per cent and by half in children aged under five.

WHO said in its World Malaria Report 2013 that expanded prevention and control measures helped produce declines in malaria deaths and illness. Of the 3.3 million lives saved, most were in the ten countries with the highest malaria burden and among children under age five, the group most afflicted by the disease.

“Investments in malaria control, mostly since 2007, have paid off tremendously,” said Ray Chambers, the United Nations Secretary General’s special envoy for malaria.

According to the WHO report, child deaths fell to fewer than 500,000 last year. The report includes information from 102 countries with malaria transmission and shows that, overall, there were an estimated 207 million cases of malaria last year, which caused some 627,000 deaths.

That compared with an estimated 219 million cases and 660,000 deaths in 2010, the most recent year for which numbers are available.

“This remarkable progress is no cause for complacency: absolute numbers of malaria cases and deaths are not going down as fast as they could," WHO Director General Dr Margaret Chan said in a statement accompanying release of the report. "The fact that so many people are infected and dying from mosquito bites is one of the greatest tragedies of the 21st century."

Malaria is endemic in more than 100 countries worldwide but can be prevented by the use of bed nets and indoor spraying to keep the mosquitoes that carry the disease at bay. The mosquito-borne parasitic disease kills hundreds of thousands of people a year, mainly babies in the poorest parts of sub-Saharan Africa.

An estimated 3.4 billion people continue to be at risk for malaria, mostly in southeast Asia and in Africa where around 80 percent of cases occur.

Chambers said progress against malaria has been threatened by funding cuts in 2011-2012, which translated into a flattening in the curve of the decline. The WHO report noted significant drops in delivery of insecticide-treated bed nets in its 2013 report.

But that could begin to ease. Last month, the Global Fund to Fight AIDS, Tuberculosis and Malaria, UNICEF, the UK's Department for International Development and the U.S. President's Malaria Initiative agreed to provide over 200 million nets in the next 12 to 18 months, which will replace 120 million existing bed nets and provide 80 million new ones.

WHO also continues to track emerging parasite resistance to artemisinin, the core component of malaria drugs known as artemisinin-based combination therapies, or ACTs, and mosquito resistance to insecticides.

Four countries in southeast Asia reported artemisinin resistance in 2013, and 64 countries found evidence of insecticide resistance, suggesting recent gains against malaria "are still fragile," Dr Robert Newman, director of the WHO Global Malaria Programme, said in a statement.

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